REMOVING A BREAST AND THE LYMPH NODE THAT HARBOR CANCER

The cancer that threatens the American female most is cancer of the breast.

This year, nearly 25.000 women in the U.S. will die of it, 55,000 others will develop the disease. Many of the deaths are unnecessary, as the American Cancer Society points out in its public warnings designed to encourage early recognition. Medical records clearly show that early recognition and treatment of breast cancer result in a high rate of survival.

Surgery's role in treating such cancer is to remove not only the breast containing the malignant tumor but also the lymph nodes that act as reservoirs for cancer cells traveling from the breast to the rest of the body. In most U.S. hospitals, surgeons perform a classical operation that is called a radical mastectomy. They make an elliptical incision, remove the breast and the outer mammary lymph nodes near the armpit and collarbone.

At Manhattan's Memorial Hospital, over the past twelve years, Dr. Jerome

Urban has developed a surgical technique that goes farther than the conventional radical mastectomy. Since a set of lymph nodes lying near the sternum (breastbone) also acts as a reservoir for cancer cells, he removes, in appropriate cases, a thick section of chest in which these internal lymph nodes are embedded. Taken out are layers of skin, muscle and bone, and this creates a window near the center of the chest.

For the surgeon, there remains a major repair job. For structural support and to diminish the size of the opening, he builds a latticework of sutures across the win dow, covering them with strong connective tissue (fascia) from an ox. After much meticulous suturing, the wound has a taut look before the skin is closed.

Dr. Urban has performed the operation on nearly 500 patients. His results show a material improvement in the survival rate over the level achieved with conventional radical mastectomy in advanced cases.

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